State of Wisconsin

Emergency Medical Services

Sample Medical Guidelines
Vertigo
Note:
Vertigo ranges from mild to severe severe enough to become incapacitating and require EMS
help.
Most patients complain about dizziness. The provider must differentiate the spinning or falling
feeling associated ith vertigo from lightheadedness! hich is another common reason for patients
to complain of dizziness! but should not be treated according to this protocol.
Vertigo can occasionall" be a s"mptom of stro#e! but is most commonl" a disturbance of spatial
orientation and motion sense in the inner ear.
Vertigo is commonl" associated ith nausea and vomiting
Priorities Assessment Findings
$hief $omplaint %izziness! Spinning or falling sensation
&'()ST %etermine onset and duration. 'rovo#ed b" changing position or turning head.
*ssociated S"mptoms+
'ertinent ,egative
%izziness! nausea! vomiting! ata-ia! and falls .ith or ithout in/ur"0
S*M'1E E-posure to #non allergen. 2istor" of $V*+T3*.
3nitial E-am *4$s and correct an" life threats
%etailed 5ocused E-am General Appearance: E"es closed! 'ale
Neuro: *1&$6! 5ocal deficits! 'upils
Eyes: ,"stagmus ith lateral gaze
7oals of Therap" Maintain *4$s and vitals
Monitoring 4'! 2)! ))! E87! Sp&9.
&rigination :;+9::< 'age =
EMERGENCY MEDICAL RESPONDER (EMR) /
EMERGENCY MEDICAL EC!NICIAN (EM)
)outine medical care
*llo the patient to assume the position that minimizes or eliminates the s"mptoms usuall" the
supine position.
4eare that as#ing the patient to turn their head or sit up! or testing the movement of their
e-traocular muscles can trigger vertigo and result in vomiting. Tr" to avoid these unnecessar"
movements.
'rovide o-"gen as necessar"
AD"ANCED EM (AEM) / INERMEDIAE
$onsider 3V+3& ,S > T8&! if approved.
3f the patient appears to be deh"drated! consider a ?:: ml bolus of ,ormal Saline
Contact Medical Control for the following:
*dditional fluid orders
PARAMEDIC
@se the folloing medication for treatment of nausea and vomiting associated ith vertigoA
o Re#lan =: mg 3V over =B9 minutes or =: 9: mg 3M
@se the folloing medication to reduce vertigoA
o "al$u% ? mg 3V
Contact Medical Control for the following:
5urther orders
,otif" medical control if e-trap"ramidal side effects develop from the )eglan. These includeA
a0 *#athisia
b0 Torticollis
c0 &pisthotonus
d0 &cculog"ric crisis
e0 4uccolingual crisis
$onsider 4enadr"l 9? mg 3M or 3V to correct e-trap"ramidal side effects
&rigination :;+9::< 'age 9